Recovery of language and theory of mind after stroke

中风后语言和心理理论的恢复

• 批准号: 10925497
• 负责人: MARGARET LEHMAN BLAKE
• 金额: $ 3.9万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10925497
• 关键词: Acute; Address; Affect; Aphasia; Area; Attention; Behavior assessment; Behavioral; Behavioral Mechanisms; Brain; Brain Injuries; Brain region; Chronic; Cognitive deficits; Communication; Communication impairment; Comprehension; Country; Cues; Data; Dependence; Diagnosis; Emotional; Evolution; Facial Expression; Frequencies; Goals; Humor; Improve Access; Individual; Individual Differences; Inferior; Intervention; Knowledge; Laboratories; Language; Language Disorders; Lead; Left; Lesion; Life; Longitudinal Studies; Maps; Measures; Metaphor; Methods; Mind; Modeling; Neuroanatomy; Neuropsychological Tests; Outcome; Parietal; Patients; Pattern; Probability; Production; Public Health; Quality of life; Recovery; Rehabilitation therapy; Right cerebral hemisphere; Sample Size; Short-Term Memory; Social Interaction; Speech; Stroke; Structure; Symptoms; Testing; Time; acute stroke; behavior measurement; brain behavior; chronic stroke; cognitive ability; cohort; executive function; health care availability; improved; inclusion criteria; innovation; language comprehension; longitudinal analysis; neural; neuroimaging; neuromechanism; non-verbal; patient population; post stroke; predictive modeling; recruit; social; social communication; social deficits; theories; tool; white matter

Project Summary Left and right hemisphere (RH) strokes occur at similar frequencies and both are associated with life-altering communication deficits. However, patients with RH stroke rarely receive speech-language intervention, likely because they do not present with obvious language deficits like aphasia. Instead, they have difficulties engaging in typical conversations which require understanding what a speaker means, especially when in opposition to what was actually said, such as occurs in sarcasm, humor and metaphors. A specific deficit in the ability to understand others’ perspectives and intended meanings, known as theory of mind (ToM) may be a primary cause of communication deficits and a critical component of differential recovery after RH stroke. Inappropriately responding during conversation due to misunderstandings of what a speaker knows and intends creates poor social interactions and negatively impacts relationships. For those living with RH stroke, communication deficits have profoundly damaging effects on quality of life. Our central hypothesis is that RH stroke causes discourse-level language deficits due to damage to brain areas critical to ToM, an essential component of social communication. Our goal is to assess language and ToM abilities from acute to chronic stages of RH stroke while collecting neuroanatomical and quality of life data. We will measure the contribution of other social deficits including the processing of emotional prosody and non-verbal cues (e.g., facial expressions) as well as cognitive deficits including working memory, executive function, and attention. To date, estimates of language and ToM deficits which occur after RH stroke and the relationship between them are inconsistent or unexplored. Most studies examine patients in rehabilitation settings who likely have large strokes and more severe communication disorders, creating a bias in our knowledge about the effects of stroke. The effects of damage to RH brain regions, their connections, and how they contribute to language recovery are also unknown, limiting decisions about treatment priorities. Lastly, whether language recovery depends on ToM is unknown as there are no longitudinal studies of communication recovery from acute RH stroke. We will address these gaps by examining individuals in a large group of acute stroke subjects, as they progress from acute to chronic stroke to evaluate the relationship between changes in language, ToM and their dependence on neural recovery. Our innovative approach combines recent advances in neuropsychological testing and neuroimaging analysis to provide converging causal evidence to validate a ToM theory of RH stroke communication. Aim 1 tests the hypothesis that language depends on intact ToM at the acute stage of stroke before functional reorganization. Aim 2 tests the hypothesis that language depends on ToM associated neural structures and connectivity acutely, before functional reorganization. Aim 3 examines recovery of language and relationships with ToM and brain structure by assessing behavioral and neural changes across the first year after stroke. Successful outcomes include understanding the behavioral and neural mechanisms underlying RH deficits, their evolution post-stroke, and their impact on quality of life. As a result, we will be able to develop better assessment and intervention tools, improving access to health care and long-term outcomes for this underserved patient population.

项目摘要 左右半球（RH）中风出现在类似的频率上，并且都与改变生活有关 沟通不足。但是，中风患者很少接受语音语言干预，可能是因为 他们没有以明显的语言来定义失语症。相反，他们很难从事典型 对话需要了解说话者的含义，尤其是在反对实际是什么时 说，例如讽刺，幽默和隐喻。理解他人观点的特定辩护 和预期的含义，称为心理理论（汤姆）可能是沟通不足的主要原因，并且 RH中风后差异恢复的关键成分。由于 误解说话者知道什么，并打算造成不良的社会互动和负面影响 关系。对于那些患有RH中风的人，沟通定义对质量的影响很大 生活。我们的中心假设是，RH中风会导致话语级的语言定义，原因是对大脑区域的损害 对汤姆至关重要，汤姆是社会交流的重要组成部分。我们的目标是评估语言和汤姆的能力 在收集神经解剖学和生活质量数据的同时，急性到慢性阶段。我们将衡量 其他社会缺陷的贡献，包括情感韵律和非语言提示的处理（例如面部 表达式）以及包括工作记忆，执行功能和注意力在内的认知定义。迄今为止， 语言和汤姆定义的估计是在RH中风之后发生的及其之间的关系是不一致的 或意外。大多数研究检查了可能患有大笔触和更严重的康复环境中的患者 沟通障碍，在我们对中风的影响的知识中产生偏见。损害对RH的影响 大脑区域，它们的联系以及它们如何对语言恢复的贡献也未知，限制了决定 关于治疗优先级。最后，语言恢复是否取决于汤姆（Tom），因为没有纵向 从急性RH中风恢复的沟通恢复研究。我们将通过大量检查个人来解决这些差距 一组急性中风受试者，随着他们从急性到慢性中风的发展以评估 语言变化，汤姆及其对神经恢复的依赖。我们的创新方法结合了最近的 神经心理学测试和神经影像学分析的进步，以提供融合的因果证据来验证 汤姆（Tom）中风沟通理论。 AIM 1检验了语言在急性下取决于完整汤姆的假设 功能重组之前的中风阶段。 AIM 2检验了语言取决于Tom相关的假设 在功能重组之前，神经结构和连通性敏锐。 AIM 3考试语言的恢复和 中风后第一年的行为和神经变化，与汤姆和大脑结构的关系。 成功的结果包括了解RH的行为和神经机制定义的行为和神经机制 中风后进化及其对生活质量的影响。结果，我们将能够制定更好的评估和 干预工具，改善服务不足的患者人群获得医疗保健和长期结局。